Genital and Sexual Pain

Genital and Sexual Pain

Genital pain is a common sexual complaint that causes women to be seen for care. Although sexual pain is not the most common sexual dysfunction, it is the one that we see most commonly in our clinic because it is often very distressing and leads to avoidance of sexual contact.

Genital pain can happen in the absence of intercourse or with intercourse. When it occurs with intercourse, it is referred to as dyspareunia.

Sexual pain can have hormonal, biologic, anatomic, or psychologic causes. 

A severe form of dyspareunia is called vaginismus which is discussed in a separate section. Patients with sexual pain can have high degrees of distress and sexual avoidance.  These conditions can lead to significant relationship difficulties and impact fertility.

Sexual pain can be experienced in many ways, including a feeling of burning or stabbing, rawness or itching, or throbbing or aching that can occur during intercourse or persist after intercourse.

Causes of Genital and Sexual Pain

Vulvovaginal atrophy (VVA) which is a condition due to hormone changes can lead to loss of  vaginal lubrication and is commonly seen in post-menopausal women as well as those on oral contraceptives.   VVA can lead to redness and thinning of the vaginal tissue and can make the vagina feel raw, itchy and dry.

Vaginismus is defined as an uncontrollable contraction of the vaginal muscles that prevents any penetration into the vagina either by her partner’s penis or tampon or even a speculum during gynecologic exam.  Women who often develop a strong fear of intercourse can develop problems with sexual intimacy and often present to their physician for fertility concerns because of inability to have intercourse. 

Vulvar Vestibulitis Syndrome (VVS) refers to a painful response to touch or pressure often preventing any type of vaginal penetration. The pain can occur even when no penetration is occurring and some women with most severe forms of VVS have difficulty wearing pants or have discomfort even when walking.  VVS is suspected when women complain of pain with penetration and the pain can be reinvoked by touching certain glands at the opening of the vagina.  VVS may be caused by some type of irritation of the opening, or vestibule, of the vagina and we have often implicated chronic oral contraceptive use as a common trigger of the condition.  

Lichen Sclerosis, or other dermatologic conditions of the vagina can lead to a loss of flexibility and tearing with occassional bleeding with intercourse. This condition will be diagnosed by a physical exam and may require a skin biopsy.

Pelvic Muscle Dysfunction or Pudendal Nerve Entrapment are causes of deep vaginal pain often noted with thrusting during intercourse. Sometimes the patient will note a ‘trigger point’ or specific location or position that causes pain.  Hip or postural issues can cause such pain as well as prior surgical procedures such as a hysterectomy or difficult childbirth are often implicated in cases of deep sexual pain.

Genital and Sexual Pain Evaluation and Management

Patients with sexual pain should have a full medical history as well as psychological history taken, including filling out several different sexual health questionnaires which help us understand better the type of pain as well as the impact it has on sexual function.  In addition to our routine physical exam, we often also undertake a close exam with a magnifying camera to better look for skin conditions at the outer part of the vagina, called the vulva, as well as entrance to the vagina, called the vestibule.

Management of sexual pain depends mainly on understanding where the pain is and what triggers the pain. Although most women consider the entire region between their legs to be part of genitals, the vagina and vulva are two separate areas of the body and are sourced by different blood supply and nerves. In addition to the skin and to the mucosa of the vagina, there can be hair follicles as well as glands that lead to vaginal lubrication and other structures that can be abnormal and cause pain.

Treatments for genital pain syndromes can include pelvic floor physical therapy, topical or systemic steroids, medications used to manage chronic pain, topical hormones applied to the vagina or other topical agents to reduce the number or firing of nerve endings, and lifestyle and dietary changes.

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Round Rock Location

970 Hester's Crossing Road
Suite 101
Round Rock,TX 78681

Phone 512-238-0762
Fax 512-341-7370

 

Lakeline Location

12505 Hymeadow Drive
Suite 2C
Austin, TX 78750

Phone 512-238-0762
Fax 512-341-7370 

 

South Austin Location

4534 Westgate Blvd
Suite 108
Austin, TX 78745

Phone 512-238-0762
Fax 512-341-7370